Benign Factors and War Stress- on PTSD

“Happy Veterans Day! Coming up now is Kings of Leeeeeon!!” screeched the shrill, young voice at 10 am on the radio on Nov 11, 2010. Lounging in the comfort of a centrally air conditioned home, with hot drip coffee in the pot and pancakes for breakfast, the Average American enjoys his public holiday with very little understanding of what the American soldier’s day was like before he became a veteran.

Sleeplessness, fatigue, aching muscles, unfamiliar food, no cell phones, very little internet, water and electricity on good days, heat and stress on bad ones- that’s what every American soldier has had to live with while fighting for his country in the two recent wars of Iraq and Afghanistan. At the tender average high-school graduating age of 18-20 years, these former Dunkin Donut and video game junkies are now subject to an isolated life in conditions they would have only earlier seen in post-apocalyptic movies.

War is no bed of roses. It’s depressing and it brings with it death, loss, more death and more loss. Post Traumatic Stress Disorder or PTSD is defined by the ‘Wounded Warriors Project’ as “an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger. You may feel afraid or feel that you have no control over what is happening”. This definition encompasses what most psychologists, psychiatrists and trauma specialists are trained to deal with in war zones. Symptoms of PTSD among soldiers in war zones, include agitation, anger outbursts, tunnel vision and the inability to solve problems and agonizing mental suffering. They talk to military men and women treated about the trauma they might have encountered and provide them skills to deal with it. But how often are these specialists trained to identify and cure symptoms arising out of the benign factors of war?

Psychologist Craig Bryan, Lead Consultant to the US Air Force for Psychological Health Promotion Initiatives and US Marines Suicide Prevention Programme describes his observations of mental anxiety among soldiers during his deployment to Iraq in 2009. “Most of the (psychological) attention given up to this point is to killing, seeing dead bodies, accidents and injuries. The other factors are taken for granted and don’t seem like a big deal but they add up over time. “ Limited food options, no laundry facilities, no internet access, 12-16 hours of military exercise every day, dehydration, no recreation and no days off, are some of these factors Dr Bryan identified as serious catalysts to PTSD in war zones. “It’s constantly unrelenting. When something big happens, you don’t have the psychological resources to deal with it.”

How do soldiers deal with this new life? “No one ever quits,” says Veteran Boyd Parker from his tenure in Iraq. “There were times when people overemphasized an injury to get out, but they never quit. The experiences are one thing but being dead tired, dealing with malnutrition, no sleep and the heat is pissing off and gets to you real bad.”

The military code of conduct teaches soldiers to toughen up. Admitting to their need for medical help is often viewed as weakness and invites stigma and insults from fellow soldiers. Without a specific ‘trauma’ or incident to identify their anxiety with, soldiers allow their stress to fester and unleash in sporadic bursts of anger or depression. Most lunch-room brawls have been allocated to this reasoning. Psychologist Craig Bryan says, “by definition a soldier would not have experienced PTSD if he did not see a threat to his life, or was exposed to trauma.” This limiting definition is the reason why soldiers refrain from therapy unless their mental health has deteriorated considerably. “Average soldiers generally wait till it’s so bad that they are in trouble, before they go in,” adds Dr Bryan.

Staff Sergeant Mike Fitz recalls his time spent in Iraq in 2003. “I went in as a boy and came out a man. Back home, trash gets taken every Tuesday, clean water comes out of the faucet, grandfathers die of old age. Normal Americans don’t get to see the life we lead. I felt like I was prisoner there.” Fitz identifies isolation from significant others as one of the main causes of stress among soldiers at war. He said that 30 percent of people deployed in his unit lost or divorced their relationships by the time they finished their term. “We had a lot of people committing suicide because of this.”

Minor steps are being taken to help soldiers deal with these stresses. Video games, movies and exercise are a common means of recreation. Soldiers with musical skills congregate and entertain themselves and the others. “What else can they do?” says Dr Bryan who is trying to promote strategic and customizable programmes which could target different military sub-cultures separately. His strategies are aimed at improving resilience in mental health and providing preventive methods as opposed to curative. “Mental health prevention is abysmal. Buying doctors in clinics is not enough. They need to live with warriors everyday to foster mental toughness so that when trauma hits, they are in better shape to deal with it.” He states that these strategies could not be demonstrated as funding for them was turned down, since they do not qualify as treatment for PTSD.

“We have failed our warriors cause we expect them to think like us, but truly we need to think like them,” says Dr Bryan.

 

 

 

“Despite all the publicity, combat stress and PTSD are just clinical words. For those of us who have served in a combat environment, our experiences never seem to fit into those tiny categories. All we know is nothing seems quite right since we came home.”

– John Melia-Executive Director WWP

 


The wrath of Alzheimer’s

If you’re on the less-desirable side of 60 and you’re reading this, you probably have a strong chance of delaying the onset of Alzheimer’s and dementia.  But that’s where the good news ends.  A team of researchers from Chicago have discovered that mentally engaging activities may prolong the arrival of this dreaded old-age curse, but if the disease does set in, it will devour an enlightened brain at a much faster rate than an uninitiated one.

Almost a hundred years after the discovery of Alzheimer’s, Robert Wilson’s team from the Rush Alzheimer’s Disease Centre of Chicago has presented a study which demonstrates the vengeful nature of this disease. Starting in the early 1990s, Wilson and his colleagues monitored 1157 participants over the age of 65, in four neighbourhoods of Chicago. Their findings revealed a much greater rate of decline in mentally stimulated seniors who contracted Alzheimer’s Disease as compared to those who remain relatively unengaged in mental exercise, before being affected by AD. But what really happens is that cognitively-charged brains were able to mask the onset of age-related dementia, which once discovered would hastily progress due to the pathological burden already present on the individual’s mind.

The team conducted its survey by asking each participant to rate their involvement in seven information-processing activities. These included watching television, listening to radio, reading newspapers, reading magazines, reading books, playing cards and games and visiting museums. The seniors had to rate them on a scale of 1 to 5, with 5 representing a daily engagement with the activity and 1 representing very little or no involvement at all. The individuals were also analysed for symptoms of AD and dementia. This exercise was repeated in the same neighbourhood every three years completing five whole cycles. Data revealed that for those without AD, the rate of decline on the activity scale was 52 percent per point, but for those with AD, the decline was 42 percent higher for each point, than the rate of normal decline.  These results may offer bleak consolation to senior citizens who are paying attention to ward of mental decline and inactivity, but as Wilson says, “cognitively stimulated individuals with AD lived their lives (before AD) always getting a little bit more out of what they had.”

This study shows that Alzheimer’s tends to ‘catch up’ and make up for lost time, but it definitely raises certain questions about its ability to represent a larger group of people.  Can results from a small population in southern Chicago establish a generalization for all of America or, for that matter, the world? Srikant Sarangi, a biomedical researcher at Boston University points out this very limitation, “the study is a good start but it’s not valid enough based on this sample set. It should, perhaps, even consider individuals younger than 65 as there are increasing cases of AD from people in their 50s.”

Sources:

Wilson, R.S. PhD; Barnes, L.L. PhD; Aggarwal, N.T. MD; Boyle, P.A. PhD; Hebert, L.E. ScD; Mendes de Leon, C.F. PhD; Evans, D.A. MD, Cognitive Activity and the Cognitive Morbidity of Alzheimer’s Disease, Neurology, Vol 75(11), Pg 990-996